<%@ include file="header.jsp" %>


<c:if test="${sessionScope.userClass == 'r' || sessionScope.userClass == 'a' }">
<h1>Add Radiology Record</h1>
${messages.new_record_msg}

<form class="radiology_record" id="add_record_form" name="add_record" method="post" action="AddRecord">

<fieldset>
	<label for="patient_name">Patient Name:</label>
	<input class="required" id="patient_name" name="patient_name" type="text" value=""> 

	<label for="doctor_name">Doctor Name:</label>
	<input id="doctor_name" class="required" name="doctor_name" type="text" value=""> 
	
	<label for="radiologist_name">Radiologist Name:</label>
	<input id="radiologist_name" class="required" name="radiologist_name" type="text" value=""> 	

	<label for="test_type">Test Type:</label>
	<input class="required" name="test_type" type="text" value="">
	
	<label for="prescribing_date">Prescribing Date:</label>
	<input class="required datepicker" name="prescribing_date" type="text" value=""> 	
	
	<label for="test_date">Test Date:</label>
	<input class="required datepicker" name="test_date" type="text" value=""> 	 

	<label for="diagnosis">Diagnosis:</label>
	<input class="required" name="diagnosis" type="text" value=""> 
	
	<label for="image">Image:</label>
	<input class="required" name="image" type="file" value=""> 	
	
	<label for="description">Description:</label>
	<textarea class="description" name="description"></textarea>
	
	<input type="submit" value="Submit"> 	

</fieldset>

</form>
</c:if>
<%@ include file="footer.jsp" %>